Sakina: All right. So the first episode that I was thinking we could talk about today was with Dr Deepak. It was quite a recent one all about pain. And that made that got me thinking about pain and how widespread it is and how many people actually experience it day to day. And the fact that it's such a wide term and it can be linked to so many different conditions. So I looked into a paper that was a global study looking at the prevalence of pain across the world in different countries. And they found that around 27.5 people adults in the world experience pain daily.
Dr Rupy: Gosh.
Sakina: So that's more than over one in four adults. So if we're looking in this office, maybe one person here would have an experience of pain day to day that they have to carry an invisible weight on their shoulder. So I thought that was pretty surprising and it seems like in the UK it might even be one in three adults living with chronic pain. And that increases with older adults. So over 75, it could move to more than one in two people living with chronic pain day to day, persistent pain, any type of pain. Those stats vary, but I think it's a pretty big number. So I think it's good to put the context on that, that it's something that affects a lot of people around us.
Dr Rupy: Yeah, and I think for the listener, if they're not in the medical field, those sound like fantastically high numbers, but as a person who spent years in general practice and any physicians listening to this, I guess it's going to be quite unsurprising because the majority of what a primary care physician would see in a typical day is going to be pain related, whether that is joint pain, back pain, headache, and then the other things which pain encapsulates are things like digestive discomfort, abdominal pain, fibromyalgia, unexplained pain. It's so far reaching and so these these studies as fantastical as they sound, it is the reality of what people are experiencing and what physicians are seeing on a day to day basis.
Sakina: Yeah, I think that's such a important thing to realize that so many people are are handling these things. So looking at as you were saying, look at the top pains experienced in the UK, back pain was the first one. Headaches and joint pain.
Dr Rupy: How much of the back pain was it?
Sakina: 53% of people.
Dr Rupy: 53%. Yeah.
Sakina: 53% for back pain, which yeah, I guess it's surprising maybe, but if you know someone who has chronic low back pain or it kind of makes sense. One thing that I wanted to look at as well is more short term pains, like menstrual cramps that I know a lot of people go through every single month. But there was a paper that I was reading about menstrual cramp which are shorter term pains, but apparently having persistent and recurrent episodes of severe menstrual cramps can predispose you to chronic pain later down the line. So chronic pelvic pain, which is also another thing that I think has a massive impact. And so all of this is kind of telling us how all these pains for different reasons and different sorts of manifestations that people experience, they take a massive toll on day to day life. It's not just about the physical pain, it's also about the social impact, your relationships, your productivity at work, how you can be in your friendships and your relationships with your family, how good of a member of society you are. And so I just think it's a good reminder that if people are irritable or a bit, they get a bit angry or they're not as friendly or anything like that, it can be because they're carrying this invisible weight on their shoulder that we have no idea about.
Dr Rupy: You've used that term invisible weight a couple of times and I think that's so powerful to remember actually. And this is probably outside of the wheelhouse of what we're going to be talking about with today, but you know when you meet someone who's grumpy, let's say, it could be in a coffee store or someone speaks to you in the wrong way or you're chatting to someone on the phone just trying to book an appointment and they're rude for no apparent reason. I just try and reframe my initial instinct to be upset and just think about that individual and what they may or may not be going through. And I think that reframing process has actually helped me quite a bit in my day to day to try and mitigate against those sort of like peaks of cortisol and those peaks of stresses that I don't generally need to experience because I'm not in that person's shoes. I don't really know what's going on in their life. So it's helped me on a on a personal basis.
Sakina: Me too. I think it's really good to think about. And I think that was the main takeaway for me from the conversation you had with Dr. D. Park is this invisible pain. So I thought maybe we could focus a bit our conversation today on that. And if you could tell us so he's really introduced this kind of third category of pain that is invisible because it doesn't have a clear manifestation. So I thought maybe you could explain what it is, how we call it and what are some of the mechanisms like how how does it work?
Dr Rupy: Yeah, totally. I mean, this episode, which was episode 276, we've chatted to Deepak before. But he he introduces us to this concept of nociplastic pain or central sensitization. And it's a third category of pain which is distinct from the other categories. So I think everyone can probably understand the first two categories. The the first being noceptive pain. And so that's, if you burn yourself or you have inflammation or some sort of tissue damage, whether that's from trauma, blunt or or sharp. It's the sort of typical thing that we think of when we think of pain. And then there's neuropathic pain. So that's more nerve damage related. So whether that is from gradual destruction as a result of type two diabetes, whether that is the real painful tooth experience that you have from something that's impacting the nerve. Again, that's the that's another type of pain. Nociplastic pain is separate from this because it's really a category of pain that doesn't come with the first two as insults. And it's a real pain, but it's generally invisible. And it's something that I perhaps didn't really appreciate until I'd been working in general practice for a longer period of time where people's experiences can certainly have an impact on their experience of pain. When I say experiences, I'm talking about their psychology, how they grew up, what experiences they had when they were kids. All these different issues can amplify their perception of the first two pains. So you can have two people to just to sort of give an analogy, you can have two people who have the same insult, whether that is inflammation as a result of an infection. And in one person, their pain tolerance is permissible for for that individual. And another person, that pain that they've experienced as a result of inflammation is amplified because of a whole preceding number of factors. And so what Deepak explained to us was there are a number of different things that we see quite oftenly as physicians, migraines, fibromyalgia, endometriosis, they don't come with a an exact playbook of how we can treat those conditions and also people's experience of those can be widely different as well. And that's something that we can't forget.
Sakina: And there is something also happening in the brain and the body that that is causing. So there's it's simplified by experiences, but there is also some mechanisms. I feel like he was talking about the role of the immune system, for example.
Dr Rupy: Yeah, yeah. So the the biology and the interplay with our immune system and our brain is is really really telling. So the pain doesn't always necessarily have a clear cause. And the there's a part of the brain where these signals are amplified and it happens at the location of the synapse. And so when you experience pain, that signal is almost gone has gone through some sort of amplifier to make that pain less tolerable than it would be for another individual. So there's that sort of central sensitization as he described it. And the other insight I I guess we got from Deepak was you can't treat this type of pain in the same way you can treat the other two types of pain that we're more used to dealing with. The noceptive pain and the neuropathic pain. So we the the common treatment for these are anti-inflammatory, analgesics, paracetamol all the way up to opioid based medications. These kind of drugs don't work for this type of pain and they can even make it worse because you're not only introducing something that isn't treating the underlying cause, but you're also interfering with the body's natural pain regulation systems. You're also introducing a whole suite of other side effects, whether that's impact on an individual's sleep, their tolerance, their digestive tract, particularly in the case of opioid based medications as well. And there was a a paper that he referred to in the Lancet that highlights non-drug treatments are considered the best approach for managing this pain long term as well.
Sakina: So if if I'm imagining, as a as a doctor, if you have someone in front of you that is experiencing pain like that, what would you recommend they do to advocate for themselves and to be heard when they're experiencing pain that maybe doesn't have a clear manifestation or clear cause?
Dr Rupy: Yeah, I think by this time, you would have established that there isn't anything physical that can be measured that is creating this experience for that person. They may have already gone through the process of trying different anti-inflammatory and analgesic medications, painkilling medications. They may have already had investigations to try and determine a cause which are unsatisfactory or inconclusive. At this point, alarm bells should be ringing not only in that individual's mind, but also the physician's mind that this is a type of pain that isn't explained by the the two common pains, let's say. I I say common, I'm saying that flippantly actually because I imagine nociplastic pain is probably more common than we give credit for. So there's the noceptive pain and the neuropathic pain that I I referred to earlier. We're used to dealing with that just throwing medications at it. This takes time and this is actually going to take a lot more effort in the way of treating it because it's more of a long term play rather than the short term play that medications unfortunately aren't going to cater for.
Sakina: So in terms of helping it, we're trying to so you were talking about this kind of overreactive system. I was trying to think of an analogy for that. And I was the only the only one I could come up with was kind of a house system, like a house protection system that is hyper reactive and instead of reacting to an actual intruder and an actual threat, it only reacts to like wind or very small things that are not an actual threat to the house. And so it's not only hyper reactive to any sort of wind or step someone walking down the street of the house, but also the kind of system that resets it and make sure to control and and dampen those alarms is not working as well. So there's like this sort of house completely overreactive.
Dr Rupy: I really love that analogy. That's such a good analogy. Just to play that back, just to just so it's clear in the listener's mind as well. So you have an alarm system of your house, your two up two down house. And your alarm system is there to identify any intruders so you're appropriately alerted to when you need to do something like call the police or grab the frying pan. But what you're saying is in this system that is hyper alert, your alarm system goes off when the wind blows a bit too much or a car drives past the house too quickly or there's a dog barking in the street and your alarm just keeps on going off. Yeah, which is an inappropriate response to a a relatively small trigger. But it's a real response. The alarm is still going off. In the same way an alarm would go off if there was an intruder coming into your house. That's a brilliant analogy.
Sakina: I think it's like, I think it's such a good way to see that it is real, because I think I I I mean, I'm not thankfully, I don't have that sort of chronic pain, but I can imagine the frustration of someone going to talking to people around them or talking to their healthcare practitioners and saying how real it is for them. And because it's hard to see, it's hard to be for people to believe you and really understand how it feels. But those reading those papers, reading the mechanisms, seeing all the diagrams in different papers about the actual ways your your pain response is amplified. It just shows me that the alarm is real. The alarm is ringing and for for these people living with chronic pain that is invisible, it does it does feel very intense and and must be really hard. So I think yeah, that kind of analogy was quite interesting.
Dr Rupy: I was just thinking about my dog as well because Nutmeg, as you'll hear, she will bark if there is someone that she doesn't know at the door. She'll also bark, whether it's my mom turning up with some lovely food. Do you know what I mean? She she responds in exactly the same way. And the outcome is the same. It's her barking. But the input is very, very different. There is something that can be a genuine threat and there is something that is absolutely not a genuine threat. If anything, it's something comforting. So, yeah, it's a it's a really good way of thinking things thinking of things. And I think, part of that is the amplification of the signals. And I think Deepak was also referring to the immune system that's housed within our gut as well. And how the state of one's digestive tract, their microbiota, how that's been shaped by everything within and and outside of their control, whether it's environmental pollutants, whether it's medications used throughout their life, the mode of delivery, as well as obviously what they're eating and how they're exercising. All these things can shape the response of your hyper alert house or your hyper alert dog.
Sakina: So to recap, if I understand correctly, correct me if I'm wrong, but so there is an amplification of the pain signals in the brain. So as we talked about this like alarm system that's going off constantly. And there is this kind of chronic low grade inflammation that can be caused by so many different things that we talk a lot about on the podcast. And that also can contribute to more pain and a higher pain intensity or feeling of pain for some people.
Dr Rupy: And just to clarify because I think we've used inflammation in two different contexts there and that's my fault. When I talk about noceptive pain and inflammation, I'm talking about overt inflammation that is acute and intense. And so whether that is from an infection or trauma, it's the kind of inflammation that has protected us for millennia. It's the stress response, it's our immune system. When we talk about excess inflammation in the context and the in the context of nociplastic pain, we're talking about indolent meta inflammation that is low grade simmering away and inappropriate as well. And the reason why someone might have this low grade inflammation are the is multifactorial. It could be from food insults, it can be from stresses, it can be from your state of the microbiota, it could be from medications. There's a whole bunch of different inputs that can lead to this low grade inflammation, which is what amplifies those signals to someone with chronic pain versus the acute high inflammation that one would experience with noceptive pain.
Sakina: So an injury or a tissue damage or something. Exactly. Exactly. Okay. So if we if we're thinking about helping and like, you know, easing those pains, treating those pains. So you you said quite clearly that a lot of the anti-inflammatory medications that are used for other types of pains are not as useful or not helpful at all. In that case, what are we looking at when we're trying to ease that pain? Is it how can we actually dampen those pain signals that are amplified and lower that inflammation? And Dr. D Park talked a lot about lifestyle. Which obviously is kind of something that we talk a lot about. So I thought he talked about stress and sleep, and he talked about the impact of childhood trauma. So I would really recommend people listening to the whole podcast because I thought the impact of childhood trauma was absolutely fascinating. But I thought because we're Doctor's Kitchen, we could dive more into food and make it as practical and clear as possible as how what sort of foods and how can food actually help lower inflammation and lower those pain signals to ease pain day to day.
Dr Rupy: This is what I love about Dr. Deepak because not only is he now a lifestyle medicine practitioner and he works in primary care, but he's trained as an anesthetist, someone who does those nerve blocks, those injections, seeing people right at the end stage of their pain journey. And the reason why he's kind of gone full circle is because he wants to go as upstream as possible. And one of the things that he's really passionate about is eating to ease pain. So he gave us some key principles to help calm the nervous system and reduce the amplification of these signals. There are lots of different ways, but like you said, we'll we'll sort of hone in on the food stuff because that's our inherent bias. And the whole food diet, so one that removes processed food is probably the best dietary strategy that anyone can can take. And this supersedes whether you're low carb or paleo, you have a particular dietary pattern that you align with. The common foundational thing to to get into into place is removing processed and ultra processed foods as much as possible. And you you looked at some research here. There was a systematic review of 43 studies that found that a whole food dietary intervention like vegetarian or a Mediterranean diet significantly reduced pain with no single diet standing out best. So it sort of emphasizes what I was talking about at the start there that it doesn't really matter about your chosen dietary pattern. What matters is actually removing processed foods. And there are lots of reasons as to why that we've talked about a lot on the podcast before. The presence of emulsifiers and fillers, the presence of excess sugars, all these things serve to irritate the gut. And if you simply remove those and add whole foods, something that our digestive tracts are naturally aligned toward, then it's it stands to reason that you're going to improve the microbial health and the diversity of that population that work in unison to reduce inflammation, to bolster your immune system, so it so it has an appropriate response to insults.
Sakina: We talk a lot about whole foods and processed food. I thought maybe you could give us a quick, very short, easy definition. What do we mean by processed or whole foods? Because it's quite vague terms that we keep using.
Dr Rupy: Yeah, yeah. So, I mean, the official classification is something using the Nova scale and you have like one to four. Putting that aside because that's more academic, I would say. When I when I talk about processed foods, I'm really talking about the outer areas of the supermarkets. So when you go to a supermarket or a grocery store, you're really looking at the whole fruits and vegetables. You're looking at the meat section, poultry, meat and fish, and you're looking at whole dairy as well. These are products that don't have any additives to them. They're essentially one ingredient foods because there's just one ingredient in there. And whether you cook them at home, steam them, lightly sauté them, yes, that does undergo some processing, but it is much less than you would find in something that is pre-packaged essentially. Now, in reality, there is always going to be some processed food in your diet. We use processed foods all the time, whether that's a culinary processed ingredient like cheese, or an additive like um pre-made gochujang, um red pepper sauce, or whether we're using something like balsamic vinegar, which has gone through some processing. Um, but I I I I guess what we want to try and emphasize is those are just flavor enhancers, whereas the main stay of your diet is going to be whole food in the in the context of what you are uh what your inputs are into your cooking at home.
Sakina: Okay, so fruits, vegetables, legumes, whole grains, like all these.
Dr Rupy: Nuts and seeds. All the BBGs. Beans, berries, greens, seeds and nuts every single day.
Sakina: And there are certain standout ingredients I guess that Deepak's a big fan of, we're a big fan of as well at the Doctor's Kitchen. If you are interested in reducing inflammation. So I would say the first thing is whole foods as much as possible and unprocess your diet. The second thing if you want to go a little bit deeper is introduce foods that are anti-inflammatory. Just by virtue of them being unprocessed, whole foods are anti-inflammatory, whether you're looking at a carrot or a brassica vegetable, uh or a, you know, um uh a strawberry, berries, whatever it might be, uh these are all going to be anti-inflammatory. There are certain standout ingredients. So diets that are rich in anti-inflammatory foods like Mediterranean diets, for example, introduce a lot of healthy fats. Um, so these are uh extra virgin cold pressed olive oil. We've done a bunch of pods on olive oil. Big, big fan of olive oil. I don't think you need to supplement with it in the form of like literally having it in two tablespoons. You can just have it in the form of cooking and dressing. It's safe to cook with at low temperatures. Definitely introduce it into your diet. And because it's technically a fruiting oil, people who are scared about seed oils, um don't need to worry about that. I don't think there are any concerns around seed oils that I've certainly seen. I just don't like the flavor of many seed oils anyway. Um, and if you go for a cold pressed seed oil like a rape seed oil that you can get from uh the UK, uh or like a sunflower oil or something like that, again that you can get from the UK, um those are certainly going to be anti-inflammatory as they have vitamin E and stuff. But if you want a safe option, just go for extra virgin olive oil.
Sakina: Because I think it also has that extra advantage of being safe for cooking, right? That is like protected when it's quality extra virgin olive oil, it can be protective um for cooking and it protects those polyphenols.
Dr Rupy: Yeah, yeah. You just don't want to take it to a high temperature. And actually, that's something that I did on the on the YouTube channel a couple of weeks, no, it was last week where I let the pan go too hot. And as soon as you put the oil in, you see the blue acrid smoke. And look, it's better to just take the hit, just pour out the oil, unfortunately, put it to one side, um, and and dispose of it appropriately afterwards, uh, and just restart. Um, but yeah, always cook at low to medium heat temperatures anyway. Um, so yeah, fats, get your oils in order, and then I would also go for your selection of seeds and nuts. Walnuts, pecan, pistachio, sunflower, pine nut, hemp seed, these are all wonderful sources of those short chain omega 3 fatty acids that again are anti-inflammatory. They also have added benefits in the form of zinc, magnesium, vitamin E. These again are introducing some of those direct anti-inflammatory constituents. Uh and they're also going to give your microbes a wonderful selection of different foods to consume as well because they're not only high in protein, they're high in fiber. So getting those seeds and nuts like every single week. I can see it now like the seven days like I've got my pecans, I've got you choose your own adventure. Try and
Sakina: Bulk buy if possible. Yeah, there's there's ways to reduce costs with those as well that I think we need to do more content on because they can be quite expensive items.
Dr Rupy: And if you're a fan of like ensuring that there aren't any uh molds and and uh pesticides on them, um because unfortunately when you do bulk buy, you you do get the uh uh inorganic substances. Uh Karen O' Donohue taught us a really simple way of amplifying the nutrition from nuts and seeds. It takes a little bit of extra work, but you essentially just put it in cold filtered water for 12 hours overnight, drain it the following day, spread it out on a sheet and allow it to dry or put it in a very, very low oven and then it activates quote unquote the nuts and seeds. Essentially what you're doing is introducing part of the germination process, which means that the um uh active chemicals are a little bit more bioavailable. The protein is a little bit more accessible as well. And it's a similar strategy that we've used for whole grains for millennia as well. So if you are worried about some of the pesticides or the external contaminants, that I think is a really good strategy. Yeah. My mom's a big fan of that. Yeah, my mom does that all the time. She always has a go at me for eating raw walnuts because she's like, you should never eat raw walnuts. You should you should at least toast them lightly because any mold that is on the surface of walnuts, you essentially cook off, you you toast off. I get that and because and actually it helps with the flavor I find. But yeah, soaking and activating quote unquote like those are things that you can do uh yourself at home.
Sakina: And it's step by step. I guess getting them in the first place and then but I like this idea because it's also kind of caring for our food, you know, and making sure that we're you know, or every process, there's a process around it and there's a bit of a practice around the foods we eat. So we're getting them and we're looking after them so they look after us.
Dr Rupy: Yeah, yeah, exactly. Yeah. It's the same thing like, you know, you can buy these veggie washes. I don't know if you've seen those. Um, but it's like basically a bit of vinegar and water and you spray it on your vegetables to remove any uh external pesticides. It's something that I think we should probably do because there are pesticides and we want to reduce our body burden of any external pollutants. We've had Professor on the podcast, you know, she's recently gone on Joe Rogan and Huberman talking about the same stuff. And it's like this sort of message is getting out there that there are too many microplastics in our food system, there are too many contaminants with heavy metals and there are certainly contaminants with microplastics um in our in our bodies, in our fat. So it's a bit of a scary subject, but there are certain things and I think it's again reframing it in the mindset of like we're caring for our food that cares for us.
Sakina: Okay, so extra virgin olive oil, if you can, nuts and seeds. What what other ingredients are on your shopping list for ease pain?
Dr Rupy: Okay, so if you imagine like Dr. Rupy in front of the uh the the kitchen cabinet, so sorry, the kitchen worktop. I've got my fats and now I've got my greens. So greens, we know, particularly those from the brassica family are anti-inflammatory. They've got indole 3 carbinol, they've got isothiocyanates, they've got all these wonderful ingredients, sulforane, which is deeply, deeply anti-inflammatory. Um, I'm getting whatever is looking great at the supermarket and I'm adding greens to every meal in the same way I'm adding nuts and seeds to every meal. So whether that's on my overnight oats as a sprinkle, whether it's on top of like I just had beans and hot smoked salmon and some um or I had some seed bread so I already had some seed in there. So, um, I'm getting seeds and nuts in every meal time and getting greens in every meal time as well. So you actually saw me like just now, I had the sun dried tomato beans and I went to the the fridge and I grabbed a handful of baby spinach leaves and I just put it in.
Sakina: Yeah, it can be that simple, just a side, a nice vinaigrette or dressing or thrown into a stew, like spinach at the end of cooking or something.
Dr Rupy: And frozen as well. So I'm a big fan of frozen greens. So if you're looking for a more affordable option that's anti-inflammatory that can help with pain and help with um uh gut health, try and lean into frozen as much as possible. So on my counter, I've got my fats and then I've got my greens. So my greens are going to be right now it's Brussel seasons, uh Brussel sprout season. Uh I've got my tennis and broccoli, I've got my um uh Swiss chard or spring greens, cavolo nero, these are my go-to greens and I try and get that in every every meal time. So that's my greens. And then I've got spices. So spices, they're always in my store cupboard anyway, but I try and replenish them every two to three months after chatting with Ren. So Ren, uh the Queen of spices as she calls herself and she's got her own sort of spice company called uh Ren's pantry. And I now only use Ren's spices at home and I try and get the small packets and just replenish them often. They cost a lot more, but the quality of them is so much better. Like in my smoothie uh after I I do a workout, I add a a big heap teaspoon of cinnamon and it's like a natural sweetener. It's incredible. And it's 100% cinnamon. So yeah, so I I always I always get that in and then
Sakina: So you would have cinnamon, maybe you add to smoothies, porridge, tea, like ginger and cinnamon tea. What other spices?
Dr Rupy: So ginger is definitely one of them and then I use chili pretty much like over everything, almost like a seasoning. Um and actually uh using good quality black pepper. So uh I always use a a grinder now and I know black pepper is just black pepper, but actually black pepper is pretty amazing, you know, pepperine, it's anti-inflammatory, it's got uh a beautiful flavor to it. I'm just using really, really simple herbs and spices in that area.
Sakina: Yeah, that's quite overlooked actually. I never think black pepper would have a benefit.
Dr Rupy: Yeah, yeah, yeah. And turmeric, any thoughts? I know it's maybe less easy to use.
Sakina: I'm trying to eat more because it's quite an interesting one related to pain. There's some studies on joint pain, menstrual pain, um or maybe that was more ginger, but turmeric and and joint pain. Yeah. Uh so that's one that I I've been trying to eat more, but it's not always easy depending on what flavors you're cooking.
Dr Rupy: Totally. Um so yeah, that could be another another staple.
Sakina: Fennel, ginger, cinnamon, black pepper.
Dr Rupy: Black pepper and garlic. Garlic. Yeah. We can't get garlic in. Yeah, yeah. But honestly, whatever herbs and spices you have in like your pantry is
Sakina: Yeah, oregano actually as well is um Yeah. has quite a high antioxidant capacity. Um so it's it doesn't have to be spices that are unknown, you know, it doesn't have to be spices that are different to your cooking style, just getting more in.
Dr Rupy: But if you were looking if you were looking at some of the highest in terms of antioxidant capacity, it's like Sumac, clove, cinnamon, uh ginger, turmeric, um and there's probably some others that I'm forgetting now, but like the real strongly star anise. The real strongly flavored ones um are indicative of the high potent, yeah, polyphenol compounds. Um so yeah, that's that's the spices, like get get as many of those as you can. And then I I get um uh my fruits in. So my fruits are mainly concentrated around berries. And because my wife loves um crispy apples, so she we get pink lady every every day pretty much with peanut butter. That's like her go-to snack. It's a good snack. It's a really good snack. It's anti-inflammatory as well. It's like, you know, you're getting your nuts in there and you're you're it's a whole food and you're getting apple and apples are full of these wonderful compounds that we've talked about before, the pectins, the different polysaccharides, these are really good for your gut as well. Um so an apple a day is something that will keep the doctor away. There's some truth in that. So I I always go for a selection of whatever I think the the fruit is looking good, particularly at the market.
Sakina: So frozen berries.
Dr Rupy: Frozen berries is my go-to. Every week I'm getting frozen berries into my diet. So, you know, you've got these fats, you've got the, you know, the um the greens, you get the spices and you're getting frozen berries. And there's so many different varieties. The one that's overlooked is black currents. Black current is so good. We grow it in the UK. It's the highest in anthocyanins. I know blueberries get like all the limelight, but that's because the studies were funded by big blueberry essentially. And not nothing against blueberry, but black currents deserve as much attention as do cranberries because they have all these these wonderful compounds in that are slightly different to blueberries. And I don't know if you've ever tried a blueberry and a black current side by side.
Sakina: Actually, I have not. We should do that.
Dr Rupy: Yeah, I try it. The black current is so much more tart. Yeah, the same for cranberries, right? That's why some people might not like them as much, but depending on what you put them in.
Sakina: Yeah, yeah, yeah. Black currents are like tart. And that is so it's like it's still sweet, but there is a obviously a bitter sour note to it. That is uh a signal to you that's the good stuff. That's the polyphenols there. Actually, you know, talking about the spices and stuff, like me and Ola, our food producer at Doctor's Kitchen, we're really trying to refine uh our store cupboard ingredients on the app as well. So when people come in on the app, they're like, okay, if I've got these like 12 spices and herbs and I've got those things in my cupboards and I've got like, you know, a couple of freezer items, I can cook everything on the Doctor's Kitchen app, all a thousand plus recipes. That is so comforting for a lot of people. And I think the aim of this pod and the aim of what we're trying to do is simplify healthy eating as much as possible.
Sakina: Make it very concrete and clear.
Dr Rupy: Exactly, yeah. And so I'm I'm I'm really excited about this new sort of onboarding where people are going to feel like, oh, as long as I've got these, I can do all Dr's Kitchen recipes. That's great. I can be anti-inflammatory, be good for my gut, good for my brain, good for menopausal symptoms. So this is, yeah, we're we're we're leaning into that quite a bit.
Sakina: Yeah, and it's quite reassuring like we talk about all these foods for most health goals. There are like there are some additions or special ingredients that have more benefits for different um needs, but all these building blocks, they are they are building blocks, you know, they they'll contribute to so many different areas of health from gut health to lower inflammation, to reducing the risk of type two diabetes, protecting the brain, like all of that, they have so many different benefits. So when you have these building blocks that we're trying to visualize on our table right now, you can then make so many meals and that will then have such a widespread impact on health and pain as well, but other things. Um, which I think is so reassuring to know that you don't have to do like so many different interventions. Um, so continuing on our list, you have these foods.
Dr Rupy: So yeah, so I've got the fruits. Beans, pulses, lentils, these are things that I always get in my diet. Now, it can be troublesome for certain people, particularly if you have, let's say IBS and you're sensitive to certain high fiber foods, in which case I would say, look, maybe you don't want to get beans and pulses in every single meal or maybe not even every single day, but you do want to gradually titrate up the dose. You want to slightly increase the amount of pulses you're getting in every day. And there's so many different types of pulses as well. You know, we had, you know, Karen O' Donohue coming in, she she basically taught us a it was a frivolous uh pulse bolognese. You know, my wife would shudder at the thought of a bolognese being made with with pulses instead of yeah, yeah. And and her mom as well. Um, but uh the the sort of bones of a bolognese were there. Um, I think like adding cooked beans and pulses into your diet every single day is a great strategy for getting more prebiotics into your food, supporting your gut microbes and these have those anti-inflammatory effects that we were just describing. So that's certainly part of my strategy of getting fiber in. They're not great sources of protein. I know like beans and pulses are, you know, heralded as as containing protein. They do contain protein, but not that much. And actually, you know, when we were doing some work for the the next book, um that's coming out in in March called healthy high protein, that um uh that really opened our eyes as to how little protein there are in beans and pulses. And if you want to hit your daily protein goals, then you'd have and if you were just getting the majority of your protein from fiber, from um these uh high fiber items, you'd have to consume a lot of fiber every single day and that can be very troublesome for not just people with sensitive guts, but anyone with a gut. And even me, if I was to try and get all my protein requirements from beans alone, I would probably struggle with that. So the other options for proteins that are also anti-inflammatory are things like tofu and tempe. And yes, I know those are made from beans, but because of the processing, the protein is a lot more bioavailable. Um, particularly in the form of tempe. And then the other sort of protein go-to for anti-inflammatory benefits, I would say a fatty fish. So anchovies, um mackerel, uh and um salmon, like I have hot smoked salmon a couple of times a week. Um, it's my go-to because of those omega 3 benefits as well. Um, but this is also where I also think a supplementation a supplement would be would be beneficial for folks. Um, to get that the the sort of added foundational level of those long chain omega 3 fatty acids, DHA and EPA that we know are really anti-inflammatory and they also have potential benefits on cardiovascular health as well.
Sakina: So fatty fish, um, tinned, uh, fresh, frozen, how to eat it?
Dr Rupy: It's a good question. Uh, so tinned is controversial because of the um uh the contaminants of tins, uh the lining, whether that's BPA, whether it's the actual tin itself. I do use tin fish, probably once a week, uh but I am conscious that um they may be contaminated. And if you are sensitive or you are trying to reduce your body burden, then I would I would say not to use tin. But I personally do use tin because of the convenience factor. Um and I always go for uh the ones in olive oil. Um as well, extra virgin olive oil if possible, but olive oil.
Sakina: And debatable, but the benefits of eating more fatty fish could outweigh the risks of um contamination.
Dr Rupy: Exactly, exactly. Everything's a trade off, right? You know, like the benefits of eating conventional fruit and vegetable produce probably outweigh the risks of pesticides. Yeah. If your other option is to have not eat them or eat processed food, which is cheaper, you know.
Sakina: Because there's way more studies on eating more plants and eating uh fatty fish. There's way more studies showing the benefits of that than studies showing the harm of pesticides and Exactly. So it still means we still want to be reducing them, but um if that means not eating them, then because you don't have the budget or the time, then I think it's still worth um buying those those foods.
Dr Rupy: Yeah, yeah. Um, so what do you think is preventing it from being scaled up like that?
Sakina: Indecision, apathy from the government. There's a whole bunch of like political opinions I have on this. Uh, I I also just don't think we think laterally about these problems. Uh, you know, we we sort of focus on the symptoms of the issue rather than the upstream um causes of the problems. I mean, there's obviously a lot more than fruit and vegetable consumption. There's insecurity, there's education, um there's access, there's uh trauma, there's single parent household. I mean, there's so many other things that we can go on about. Um, but this is a big, big impact. I I think this could have a big, big impact. And also when you look at like the rise of fruit and um uh food banks and the reliance on food banks and what we serve people in food banks, you know, I'm I'm all for giving people food, but unfortunately, as great and as as uh incredible as a lot of these organizations are that run the food banks, the quality of the produce that is available in these food banks is really, really poor. And it's no wonder that the consumption of ultra processed foods is unfortunately rising. And they're in a rock and a hard place because you can't operate a food bank without having some foods that are non-perishable, i.e. they you know, the shelf life is extended. So whether that is, you know, can of processed um foods or uh whether it's snacks, whether it's, you know, the the hyper palatable foods unfortunately that are non-satiating, low in protein, low in low in water, um and high in calories. This is the the the the troubling situation that we find ourselves in. So, yeah, I that's why I think to counter that inevitable reliance on ultra processed food, the Alexandra Rose Foundation and their sort of focus, I think is something that everyone should should really get behind. Um and there is a lot of change. Like I shared a meeting with Alexandra Rose, um and a number of other organizations. There were supermarkets in the room, there were other charities, there was fair share, there was Felix, uh there were farmers. And everyone wants to see this happen. Everyone wants to see this change, but there is a lot there's a lot of blockers to it. Um, you know, and I think when you're constantly firefighting, it's, you know, the the analogy is like a general practitioner who wants to do lifestyle medicine in in practice, but you've got someone who's in acute pain, or you've got someone who is um, you know, has has uh a myriad of medications already, or they're the the real sort of desperate part of their patient journey, you're not going to have time to talk to them about exercise. You're not going to have time to analyze their diet. You're not going to And this is part of the reason why Doctor's Kitchen exists to fill that void so we can have like an hour and a half conversation about exactly what fruits and vegetables you should be consuming, why you should be consuming those, what quantities you should be consuming them in, how you up for budget foods, uh how you maintain a consistent habit of healthy eating and why that has protective effects on uh issues like type two diabetes, poor metabolic health, obesity, dementia, etc, etc. Pain, inflammation, yeah. All these different things. So this is why we we do what we do at Doctor's Kitchen is to try and fill that void that unfortunately you cannot fill in an eight minute on average consultation in general practice and A&E and and even secondary care. Um, this is why you need these kind of uh spaces where you can really go deep at a point where people can still understand it and actually take change uh take uh take action.
Sakina: Yeah, I think it's very um impactful, important to see all those blockers and all those problems, but as you said, like where we're contributing is a mindset shift as well because there's all these blockers of access, but I think a big thing as well is mindset where, you know, even before starting this job, I would not believe that just eating more vegetables would have such a big impact, you know, it sounds we're so used to pills and quick fixes and something that's going to have an immediate visible impact that anything that takes a bit more time and is a bit more of a small change that adds up is just we believe in it way less. And it takes so much convincing to even believe in the power of uh eating more certain foods or a walk or you know, all these things that are just almost too simple to be true. So when we see the mechanisms like we talked about today, when we see the data and and all of that, I think it's helping shift that mindset and then when we have people like um uh charities like the Alexandra Rose charity who are helping make that accessible for everyone. I think yeah, it has such a big impact. Um so yeah, so I think to recap on this chat that we've had, we've had a lot of conversations, but we've covered kind of three different podcasts that we had in the past few months. Hopefully this is a like all-in-one space for you to um hear our our most impactful insights. What would you want people to come out of this podcast with?
Dr Rupy: I would say, uh, let's keep it super simple. Um, add one anti-inflammatory food to your uh meal tomorrow. It could just be one meal as well. So that could be nuts or extra virgin olive oil if you want to invest in a good quality extra virgin olive oil. That's up to you. Add a green, choose a green, just get into the habit or try and practicing, okay, I've made this meal, how do I add a green to it? You can steam it, sauté it, you can just mix it in, you can have it raw on the side if it's something like a rocket or a leaf or something like that. Um, or it can be like another herb or spice or something that will introduce a sort of like flavorful element as well as those anti-inflammatory benefits. So try and add one anti-inflammatory ingredient food to your meal tomorrow. Second thing is move for 30 minutes. Uh, try and aim for like, if you can go for five days with 30 minutes uh of movement, walking or cycling, whatever it might be. If you can't do 30 minutes in one stretch, go for 10, 10, 10. I think that's that's still something that will would have benefits. It stands to reason that there would be benefits of that. Um, and the third thing is check out Alexandra Rose and support where you can. There's a donation button there on their website. You can donate as little as a quid uh or you know, more if you wanted. Um they're doing a real push for raising because a lot of charities I think at the moment are under pressure um given the state of our uh economy. Um so I think that would be a great Christmas present as well, you know, if you gift something for someone and told them the story of the fruits and vegetables and like even shared the podcast episode with Jonathan Pauling talking about it. Um I think these little changes will compound and the more people know about it and the work that they're doing actually helps with our message as well with Doctor's Kitchen in terms of really promoting fruit and vegetable consumption um across the UK and just making it a lot more accessible. And if the government was to like subsidize as heavily as they do for other products in our uh food ecosystem, you'd be looking at a healthier nation, you know, you can imagine like a wealthy nation should have incredible, especially a wealthy nation that provides universal basic healthcare uh free at the point of delivery, should really be investing in the health of the nation by um making healthful ingredients accessible at a really, really low cost where it it just becomes the default option. You know, you go into a supermarket, you don't have to decide between an apple and a Snickers bar. It's like, well, of course I'm going to have like apples because they're so cheap. Yeah. But but farmers are still supported. And farmers are still supported. Yeah. And this is why you need the both. You can't just like have as cheap as possible apple without really thinking about the grower. You've got to have it whereby the state intervenes because intervening in food actually lowers the bill when it comes to the NHS and the healthcare service.
Sakina: Yeah, I think that's a brilliant recap and we're building momentum, you know, like we're trying to move for a greater change and and it's great to be part of that. So
Dr Rupy: Epic. I can't wait to our next uh our next catch up.
Sakina: Yeah, it's fun.
